Indira Tikhonova

Primary specialty

DentistTaxonomy code 122300000X

License

04865 Issued in NH

Practice address

309 N Main St
Travelers Rest, SC 29690-1527

Phone

(864) 610-6188

NPI assigned

Jun 1, 2023

Last updated

Oct 15, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dentist

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: itikhonova846129@direct.ochin.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Health Centers of Southeastern Iowa Inc

  • Federally Qualified Health Center (FQHC)
  • West Burlington, IA
  • NPI 1255339750
  Medicare reassignment NPD
• Community Health Centers of Southeastern Iowa, Inc

  • Federally Qualified Health Center (FQHC)
  • West Burlington, IA
  • NPI 1144044637
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1396438636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 N MAIN ST",
            "city": "TRAVELERS REST",
            "state": "SC",
            "postal_code": "296901527",
            "telephone_number": "864-610-6188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 N MAIN ST",
            "city": "TRAVELERS REST",
            "state": "SC",
            "postal_code": "296901527",
            "telephone_number": "864-610-6188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIKHONOVA",
        "first_name": "INDIRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-01",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NH",
            "license": "04865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Carol Tankersley, LMFT
• Nathan Lee Tate, MSW, LMSW, LCSWA
• Sybil Tezza, FNP
• The Dental Retreat at Mountain Park
• The Dental Retreat LLC
• Anthony B Tomkins, MSPT
• Gerald Drew Toney
• TR Talkers, LLC
• Trailhead Chiropractic
• Trailhead Family Dentistry LLC

• Dentist in Travelers Rest, SC
• Providers in Travelers Rest, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.